Archived: Osbrooks Also known as Moving Forward

Updated 30 September 2019

Moving Forward Osbrooks provides a private residential detoxification and rehabilitation service where clients fund their own treatment. Moving Forward Osbrooks provides medically monitored detoxification and a therapeutic recovery programme based on the 12-steps model. It has been registered at its current location with the CQC since December 2018 and operational since January 2019. The service was previously registered at a different location, which closed in May 2018.

There is a registered provider in place who also acts as the service manager.

The service is delivered in a large Grade II listed manor house near Dorking, Surrey. The building is set in 14 acres of grounds, with a large rear garden, complete with swimming pool, hot tub and gym.

The service is registered to provide treatment to up to 10 clients over the age of 18. There was accommodation for six clients on the first floor on the main building, with one shared room and all the others single rooms. Some with en-suite and some shared bathrooms. One bedroom was adjacent to the office on the ground floor for clients who were undergoing the early days of detoxification. There were also two bedrooms designated for staff use with a shared bedroom. Therapy, activity and communal rooms are located on the ground floor. There was also a small outbuilding which contained a gym.

The service has a contract with a local GP surgery to deliver prescribing for a medically monitored detoxification. This means that clients may be given medicine to manage their withdrawal from substances, supported by staff - but do not require 24-hour medical supervision.

All clients who have used the residential services could access after-care for up to three years. After-care consists of attendance at the daily groups and support from staff.

Clients at the service self-funded their treatment. They either self-referred or were referred to the service by an agency. The service did not take NHS funded clients or referrals of people detained under the Mental Health Act. Clients typically stayed at the service for 28 days.

There were five beds occupied at the time of our inspection.

This was the service’s first inspection.

Moving Forward Osbrooks is registered to provide the following regulated activity: Accommodation for persons who require treatment for substance misuse.

Updated 30 September 2019

This was the first inspection of the service. We rated it as inadequate because:

• The provider failed to ensure that information on client risk was centrally located in the client file.
• Care plans did not include all risks identified at the initial assessment. The client files did not include the risk assessments; nor did they contain records of risk reviews or risk management plans. This meant that not all client records contained consistent information regarding risk - including assessment documentation and prescribing information. As a result, this important information was not easily accessible to staff to inform the care that they provided.
• The provider failed to ensure that staff always responded to warning signs and deterioration in people’s heath or changing risks.
• The provider failed to ensure that all staff were properly trained in using detoxification or withdrawal management tools and could therefore manage detoxification safely.
• The provider failed to ensure that all re-accreditations, such as the managers nursing registration, were completed in time and all staff had up to date DBS checks completed.
• The provider had failed to ensure that out of date fire safety equipment had been replaced.
• Not all staff were aware of the admission criteria, nor did they always follow them.
• We were not assured that the records were an accurate record of the medicines prescribed and administered or declined, nor a full reconciliation of the client’s medicines on admission.

• Up-to-date care plans were not always present or complete in the client files. We found the care plans to contain pre-populated generic information and whilst short- and long-term goals were identified there were limited steps on how to achieve them.
• Whilst staff used recognised rating scales to assess and record severity and outcomes, not all staff were trained in using them.
• The provider failed to ensure that effective records were kept in order to ensure the safe management of the service, included staffing rotas, documents about the running of the service and client records including medication charts.
• Governance policies, procedures and protocols were not regularly reviewed and often out of date or had passed their renewal date.

However:

• The full-time staff had completed their mandatory training, including safeguarding, and all staff received an induction when they joined the service, which included the completion of the Care Certificate.
• Staff completed some comprehensive assessments with clients on admission to the service, including consent to treatment, client details, breathalyser reading, medical and social background, alcohol dependence questionnaire and basic physical observations.
• Staff provided a range of care and treatment interventions suitable for the client group. These included medication, activities, counselling and therapy. A structured timetable of therapy and activities was offered to clients Monday to Saturday.

• Clients told us that the staff treated them with compassion and kindness and that the staff understood the individual needs of clients and supported clients to understand and manage their care or treatment.
• The service held monthly quality and innovation meetings for staff and had evidence of initiatives to improve the service, such as an improvement log.
• Clients were made aware of the risks of continued substance misuse and harm minimisation.

The inspection team identified concerns that were placing, or could place, the clients at Osbrooks at risk. CQC sent a Section 31 Letter of Intent to the provider following the inspection. A letter of intent describes these concerns to the provider and asks that the provider responds to CQC with plans to rectify the issues immediately otherwise further enforcement action could be taken. The areas which CQC asked the provider to address were:

1. The provider must ensure that Clinical Institute Withdrawal Assessment for Alcohol – Revised (CIWA-Ar) assessments scores are appropriately responded to and provide evidence that all staff understand the intervention required according to the CIWA-Ar score.
2. The provider must ensure that the correct tools are used when assessing client’s withdrawal and that all staff are aware of which tool to use depending on which substance treatment plan the client is on.
3. The provider must ensure that the GP assessments for each client are contained in the client files and accessible to all staff working with the client.
4. The provider must ensure that all known risks and identified risks are recorded, and appropriate action is taken to mitigate the risk and that this is recorded in the risk plan for all clients.

The provider responded in a timely manner describing the adequate and immediate actions taken to ensure the safety of clients at the service in relation to these four areas of concern. Details of the concerns and the provider’s response are contained within the report findings.

Updated 30 September 2019